Obamacare isn’t a train wreck. Here’s why.

For years, critics of Obamacare (Affordable Care Act), have predicted that it would turn out to be a “train wreck” — or something worse. But now we know that by every objective measure, the ACA is working out pretty darn well. Let’s run through the “train wreck” predictions, and what we now know to actually be the case:

Typical was the claim by Obamacare opponent Avik Roy that “health care spending will explode under Obamacare.”

But now we know that:

In 2012, total health care spending increased by 3.7%, the “lowest rate since 1960.” Most recently, the CBO substantially reduced its forecast of projected deficit spending, largely because of the slowdown in health care spending. And the CBO’s director confirmed his agency’s long-standing view that the ACA will lower the deficit.

The ACA may not be totally responsible for the health care spending slow down — the same thing is happening in other wealthier countries reports the New York Times.

But the facts to date show that Obamacare surely has not caused health care costs to skyrocket, or the deficit to explode; rather, health care spending has slowed and deficits are going down.

Speaker of the House John Boehner was one of many ACA critics who made this claim.

But now we know that:

Far more people gained coverage than lost it.

The Washington Post’s independent fact-checker wrote in March that there’s “more than enough to demonstrate that no matter how you count it, there has been no net loss in insurance coverage.”

In fact, today we now know for sure that Obamacare has allowed far more previously uninsured people to gain health insurance coverage than lost it. It’s not even close. Kaiser Health News reports that three independent studies found that the ACA “reduced the number of uninsured adults by 8 to 11 million people.”

Politico, a highly respected, independent and non-partisan news source for DC policy wonks and politicians, concludes that “by now, the trend is unmistakable: Millions of people who didn’t have health insurance before the Affordable Care Act have gained it since last fall. The law is not just covering people who already had health coverage, but adding new people to the ranks of the insured — which was the point of the law all along.”

To recap, these are the plain and simple facts:

Opponents of Obamacare predicted that Obamacare would become a train wreck because health care spending would skyrocket and the deficit would explode as a result. The fact is you’d have to go back over half a century to find a time when health care spending has grown so slowly; the CBO says that federal deficit spending is declining (largely due to the slowdown in health care spending), and that the ACA will continue to lower the deficit in the future.

Opponents of Obamacare predicted that it would become a train wreck because millions more would lose coverage than gain it. But the fact is that under Obamacare, the uninsured rate is the lowest it’s been since at least 2008, according to Gallup, with the rate dropping across nearly every subgroup — extending coverage to some 8 to 11 million previously uninsured adults.

For the millions who have gained coverage, Obamacare today is looking a lot more like a lifeline than a train wreck.

But it’s not only the uninsured who benefit. Don’t we all share in the benefit of having lower health care spending, lower deficits, and from seeing fewer of our neighbors delay getting needed health care because they couldn’t afford health insurance?

Bob Doherty is senior vice president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

Obamacare isn’t a train wreck. Here’s why. 35 comments

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Thomas D Guastavino

Is there a typo? Should the title actually be “Obamacare isn’t a train wreck, yet”?

NewMexicoRam

Yes, the entire package has yet to be seen, with so many deferrals and changes.

Thomas D Guastavino

The unintended consequences are just beginning.

James O’Brien, M.D.

What a balanced and nuanced article written with complete objectivity.

Patient Kit

In October 2013, predictions were rampant that “nobody” would accept the exchange plans — that patients who buy a plan on the exchange would be unable to find any good doctors or hospitals that will accept them. The train wreck prediction was that patients could buy plans but would actually be unable to use them to access healthcare.

Ten months later, in August 2014, I can’t find a single hospital in NYC that is not accepting some or most of the exchange plans. And that includes good hospitals like Memorial Sloan Kettering, Hospital for Special Surgery, Lenox Hill, NY Presbyterian, NYU, etc. The hospital where I’ve been being treated is accepting 7 of the 10 plans offered on the exchanges (meaning UHC, Oxford, Empire BC, Emblem, etc — all levels, i.e. bronze, silver, gold, platinum of those 7 plans). My awesome (hospital-based) doctor is accepting at least several of them.
I’m currently doing the research in case I need to buy a plan on the exchange.

Lisa

I’ve looked at plans in the CA exchanges. The gold plan offers coverage that compares to my employer provided policy. It costs about the same on a monthly basis. And all of the my doctors accept that plan.

Several of my friends (self-employed) bought plans through the CA exchange. They say the plans are accepted by their doctors, with one exception. My neighbor said her ophthalmologist doesn’t accept the plan she selected. However, she says she is paying substantially less for insurance coverage. I also know people, very low income, who were able to get medi-cal coverage for which they were not eligible previously.

Patient Kit

CA and NY seem to be two good states to be in for this major transition in our healthcare system — which makes sense because CA and NY are two great states to live in, in general. So far, I’m not finding the narrow provider networks that were predicted. But then, there are hefty phone book-sized directories of provider options here for folks who are covered by Medicaid. I imagine MA is a good state too. People are really going to suffer in the states where the political powers are hell-bent on trying to make the ACA fail.

QQQ

I am so glad big daddy government is in good hands. Besides the top elected officials, those selected to fill positions under them are also to be admired. Why is it such a big deal that a government office that requires citizens to have proof of seven years in case of getting audited, when they can’t keep track of their own? Getting kind of tired of the double standards being allowed and then these same people getting bonus’s and promotions. The list of scandals, cover ups and wrong doings could fill pages-sort of like the botched ACA that was forced down our throats. Doesn’t anyone have the intestinal fortitude to take action and get our system back on track?

Oh, by the way. As of today you can collect your $2,500 saving by calling the government switchboard, they are cutting checks today, call 1-888-SUCKER.

Paul

Centralized, bureaucracy-heavy systems are prone to fail, and spectacularly so. When all the eggs are in one basket, mistakes become catastrophic.
I don’t like the concept of Obamacare, or the ACA, because it increases risk by centralizing decisions. Health care policy will be dictated by bureaucrats and wonks in Washington without accountability. Many of those people may well be dedicated to good results, but many will not be. They will be dedicated to making the numbers look good, by whatever metric other wonks cook up.
Another problem the proponents of the ACA might not be considering is the inclinations of future politicians. If you are JFK, would you expand the powers of the presidency if you knew that Richard Nixon would be a future president? If you were Bismarck, would you drastically expand the state, knowing that within 60 years a community organizer named Adolf Hitler would have dissolved Parliament and harnessed the state to his own evil ends?
Centralized power will eventually be abused. The Founding Fathers were wise to divide and hobble government power.
So I think Obamacare will be a disaster. How remains to be seen.

Ava Marie Wensko George

Well, Germany, who has been using this type of health care process for 120 years, would disagree with you, as would I.

Thomas D Guastavino

Physicians in Germany are organized into trade unions and act to balance the centralized power of the government. I would be more then happy to do the same thing here.

Patient Kit

And I would fully support doctors’ organizing and collectively bargaining and having a real voice in this process. Is there any sign of doctors’ starting to get organized?

Thomas D Guastavino

Its been said that organizing physicians is like training cats. However, the main opposition has been the possibility of a work slowdown, which would be an absolute last resort.

Patient Kit

In general, I love both cats and docs. But cats have no good reason to get organized. Docs do. I could be wrong (!), but I think that for a long time, docs in the US thought they were untouchable and above needing to be organized into a union. Strikes and work slowdowns are actions of last resort — and never easy — for anyone. But sometimes they are necessary. Our whole country, in all industries and sectors, is feeling the result of the demise of labor unions. The employers have all the power. Docs are just finding out now what that feels like.

Thomas D Guastavino

Interesting. So you would have no problem with health providers going on strike?

Patient Kit

I didn’t say that. I would hope that if doctors ever get organized enough to consider striking, that they would first try other strategies to gain leverage and a real voice. Obviously, the sickest patients must be cared for and not abandoned during any strike. You can’t just let patients die while you strike. Not only would that be unethical but it would result in a failed strike and really bad publicity for doctors. But I wouldn’t have a problem with a “limited” strike, meaning canceling elective procedures and uncritical patient appointments that cause inconvenience, not danger to your patients.

Nurses strike. How have their strikes worked? And what about docs in other countries who are unionized? Have they gone on strike? What were their strategies? Did they work? If doctors in the US ever consider organizing into a union, they should be talking to doctors in other countries to learn from their experiences with being organized.

Thomas D Guastavino

Im confused. You bemoan the demise of unions in this country yet you want to deny health providers that same privilege. Fireman and police provide vital services yet no one begrudges them the right to strike. Which is it?

Patient Kit

Many firefighters and police are organized into unions. They certainly are here in NYC. But how often do you see firefighters and police go on strike? Not very often. You’re acting like the most extreme labor action — a strike — is the only reason to be organized. Most labor unions collectively bargain without ever going on strike. Of course, you have to have the right to strike and it has to be a credible threat. But anyone who has ever been a member of a union always hopes to work things out with employers without the need to strike. Why don’t you start by exercising the right to have a place at the table and to negotiate or by organizing a solid public awareness campaign before jumping ahead to the extreme of a strike? And I did offer the idea of a limited strike that could “hurt” employers, inconvenience patients but not actually kill patients, which would be very counterproductive, to say the least.

Thomas D Guastavino

So……..you would have no problem with health providers having the right to collectively bargain and, as a last resort, the right to strike.

Patient Kit

No problem. I would hope that doctors would try everything possible first before striking. But, yes, you should have freedom of association, the right to organize, to collectively bargain, to protest and, yes, to strike.

Thomas D Guastavino

Fair enough. As long as physicians were organized and had those rights I would have no problem considering socialized, private, direct pay, or any other kind of health system you think would work.

Paul

Congratulations, you completely missed my point. Centralizing power is bad when lunatics are in charge. And Germany had a lunatic in charge from 1933 to 1945. The extermination of the mentally and physically “unfit” beginning in 1939 was possible because of centralized state power and control.

SteveCaley

Culturally, we have a trend towards conformity, bureaucracy, mediocrity and rules; although we deny it. Until we can look at that, we will erect huge bureaucracies that do not particularly work.

Joe

Since the original ACA scoring from the CBO (and a huge chunk of the savings) were predicated on letting the SGR cut kick in, I’m not gushing over the savings just yet. Spending is slowing down because access is being cut.

Eric Goldberg

What a complete waste of space this article is. Obamacare isn’t a complete trainwreck YET because it hasn’t been fully implemented YET. The way the law is written, the worst consequences of Obamacare won’t hit until several years down the line, by which time he will be long gone from office. And this is, in my opinion, entirely intentional.
The only people who could possibly think this law is well-written or sustainable in the long run are people who have no comprehension of simple economics, or math, or both. Which, come to think of it, describes essentially Obama’s entire voting contingency.

Patient Kit

Really? President Obama’s “ENTIRE voting contingency” has no comprehension of simple economics or math? (I think you might mean constituency?) That sounds a little like you’re saying that those who don’t agree with you are idiots.

[Full disclosure: Not only did I vote for Obama but I worked on his first presidential campaign.] Personally, I think the ACA is a mess and I’m disappointed in it but it’s better than what we had pre-ACA and, I hope, a starting point toward a better healthcare system in this country — like many other countries already have. We have to move forward, not backward, as we reform our dysfunctional healthcare system. The “good old days (for some)” are in the past.

Thanks to the ACA, I and everyone else who has a pre-existing condition can now buy health insurance. It’s not perfect but it’s better than being seriously ill and uninsured. Try living that reality and you’ll see what I mean. Believe me, I live and breathe real-life economics. Ultimately, what I want to see happen is a comprehensive single payer national healthcare system that provides access to affordable healthcare to every American. I would prefer to see a single-payer system and cut out that much-hated insurance middleman. But short of a single-payer system, the health insurance industry is a necessary evil and here to stay. I want healthcare in the US to cease being, first and foremost, a huge profit-driven business.

I know, I know…..you’re going to say that we can’t afford that kind of system. There’s only so much to go around and, in America, somebody always has to lose for someone else to win. Someone always has to have no pie for someone else to have a bigger slice of pie (or hang on to whatever pie they’ve got). I just flat out do not accept the assertion that it’s an economic reality that millions of Americans must go without medical care.

Thomas D Guastavino

Im curious. If you were designing a health care system from scratch, how would you do it? Please be specific.

Patient Kit

I’m not ignoring this question. I’m just posting on the fly right now and don’t have time to answer such a complicated question from my phone. Not that I have all the answers you seek. I don’t and I know that I don’t (and you know that I don’t). That’s why I’m here talking about this, exchanging ideas and experiences with both doctors and other patients. But I don’t consider the ACA to be the endgame of healthcare reform in this country and I don’t want to go back to what we had pre-ACA. It’s frustrating to hear doctors romanticizing the past when it was not good for a lot of patients. That’s why the ACA happened. Because our system before was not working for too many people.

Thomas D Guastavino

So…..take your time. Think it over. You seem to have a lot of issues with the current health care system. I ask again. If you were designing a new health care system from scratch, how would you do it?

John C. Key MD

You are to be commended for being forthright about your commitment to Obamacare and left-wing lunacy, but I fear that your healthcare experience is much more limited than you think it is. Most of your statements just don’t pass the reality test. You say you don’t support healthcare being a huge, profit-driven business, but the ACA is joined at the hip to big insurance, big hospitals, big CorpMed, and big government. To deny same is pure naivete. At least writers like Mr Doherty are paid lackeys of the systems they support.

Looks like Lob Wedge Jesus will definitely listen to the highest bidder.

Ava Marie Wensko George

Well, you knew when you wrote this all of the very interesting people with severely negative opinions would crawl out of the woodwork and slam you with their “feelings” rather than facts. You know how those darn statistics really bug them. Keep up the good work….The more they complain, the more we know the ACA is working.

SteveCaley

If ACA is doomed, it is because it has not corrected the lethal flaws in the American healthcare machine that have been laid down for decades.

Thomas D Guastavino

Im sorry, what did I miss?

Ava Marie Wensko George

I totally agree with you ….. I call it the ACA too….Look at the people in Kentucky….When they called their exchanges Kynect the response was 100% positive. If they called it Obamacare or the ACA, it was rejected. It is all about the President and not about making healthcare coverage accessible to everyone for sure.